This weekly roundup thread is intended for all culture war posts. 'Culture war' is vaguely defined, but it basically means controversial issues that fall along set tribal lines. Arguments over culture war issues generate a lot of heat and little light, and few deeply entrenched people ever change their minds. This thread is for voicing opinions and analyzing the state of the discussion while trying to optimize for light over heat.
Optimistically, we think that engaging with people you disagree with is worth your time, and so is being nice! Pessimistically, there are many dynamics that can lead discussions on Culture War topics to become unproductive. There's a human tendency to divide along tribal lines, praising your ingroup and vilifying your outgroup - and if you think you find it easy to criticize your ingroup, then it may be that your outgroup is not who you think it is. Extremists with opposing positions can feed off each other, highlighting each other's worst points to justify their own angry rhetoric, which becomes in turn a new example of bad behavior for the other side to highlight.
We would like to avoid these negative dynamics. Accordingly, we ask that you do not use this thread for waging the Culture War. Examples of waging the Culture War:
-
Shaming.
-
Attempting to 'build consensus' or enforce ideological conformity.
-
Making sweeping generalizations to vilify a group you dislike.
-
Recruiting for a cause.
-
Posting links that could be summarized as 'Boo outgroup!' Basically, if your content is 'Can you believe what Those People did this week?' then you should either refrain from posting, or do some very patient work to contextualize and/or steel-man the relevant viewpoint.
In general, you should argue to understand, not to win. This thread is not territory to be claimed by one group or another; indeed, the aim is to have many different viewpoints represented here. Thus, we also ask that you follow some guidelines:
-
Speak plainly. Avoid sarcasm and mockery. When disagreeing with someone, state your objections explicitly.
-
Be as precise and charitable as you can. Don't paraphrase unflatteringly.
-
Don't imply that someone said something they did not say, even if you think it follows from what they said.
-
Write like everyone is reading and you want them to be included in the discussion.
On an ad hoc basis, the mods will try to compile a list of the best posts/comments from the previous week, posted in Quality Contribution threads and archived at /r/TheThread. You may nominate a comment for this list by clicking on 'report' at the bottom of the post and typing 'Actually a quality contribution' as the report reason.
Jump in the discussion.
No email address required.
Notes -
From the impression I've gotten from surgeons and doctors who know many surgeons, this doesn't surprise me. Surgeons have a bit of a reputation for being high class technically skilled butchers. They operate on flesh, but their treatment of it is closer to that of a car mechanic than most other doctors. I think they perhaps see it as a very easy case of tumor removal. @self_made_human may have more insight.
Honestly, my approach is, fuck it, why not?
Well, there are actually reasons why not, such as the hope we can find a less ghoulish cure, things like mirror therapy for phantom limb (well, that one's already gone, its just that maybe there's an equivalent), or the fact that they might go on disability.
But if someone who is otherwise healthy and financially sound wants to chop off pretty much anything for any reason, my opinion as a psychiatrist-about-to-start-training is a shrug, presuming I was convinced that nothing else we could do would help.
Surgeons aren't that gung-ho in my opinion, maybe it's because I worked too long in Onco Surgery, but I've seen more cases turned down as non-resectable or not worth it than those that were done knowing it was futile. Surgeons usually want what's best for the patient too, even if it's in conflict with their wallets. They're rich enough that's not the biggest deal.
Chop off a mole, a limb, a dick, anything at all. As long as you make sure you're not a burden on the rest of us, it's not my business, unless you ask me for my advice.
I feel like psychiatrists are more skittish because they have gone down the "fuck it" lane before and caused horrors. The healthy and financially sound are surprisingly easy to lead down a garden path.
Eh, that's not really my experience with them. What exactly do you think psychiatrists get up to? Leaving aside the gender-affirming types.
Do you want the long list or the short list?
Off the top of my head, naming only the ones that are undeniable crimes against humanity and beyond debate:
Going full Szasz and calling mental illness as a category a myth in reaction is probably going too far, but let us not pretend that the field has clean hands. Few other disciplines ought to be as deeply attuned to the depravity mankind can let itself get up to under the proviso of "doctor says it's okay".
All well and good, might as well condemn biologists for Lysenkoism at this point.
None of those are really a knock against the field as it exists today. I'm here to dish out drugs, that's why I'm a psychiatrist and not a psychologist.
And most practising psychiatrists, unless they're still seeing patients at 80, have nothing to with any of them really.
Interesting response. I have always assumed, or more correctly, hoped, that psychiatrists had some degree of expertise beyond psychologists that was not simply the ability to, as you have put it, "dish out drugs."
The dishing out of drugs (for whatever) seems very (read: too to my way of thinking) common in Japan at least. Considering most medical interventions are created with the general human in mind, and are therefore prone to error when prescribed for individuals (whose idiopathic digestive, cardiovascular, endocrine, and central nervous systems are all slightly different), I am sometimes surprised medicines work at all. In fact I doubt that many of them do without causing other issues (see: statins). MDs at least in my own experience as a non-King with no real personal physician of my own, seem more likely to send people to the pharmacy (where, at least here, there is often rigorous questioning and examination of one's 薬手帳 or personal drug diary that everyone's supposed to carry to the doctor, that has every prescription drug you've taken for the last however many months/years logged.) than sit down and ask about diet, exercise, family history, etc. to get at whatever the hell may be causing the current complaint.
I guess I am hoping psychiatrists are at least interested in possible causes--of, say, depression--rather than being focused, from the moment introductions are uttered, on measuring the patient up for which drug will induce the sweet, sweet, happiness (or whatever).
I mean, we obviously study most of the same topics as psychologists do, we have the additional benefit of prescription drugs where simply talking to the poor bastard doesn't suffice.
Doctors are in relatively scarce supply, so there's a degree of specialization of labor, if it's cheaper and easier to let the people trained particularly in talking handle that bit, that frees us up to do the job of doling out drugs. But I struggle to think of anything a practising psychologist can do that a psychiatrist can't. I consider the ability to make problems go away with pills a big plus in my book.
But there's a tradeoff here, the time you spend with a psychiatrist who usually charges much more per hour, and that time is better spent with less talking and more prescribing, within reason.
Of course we argue about the causes of depression and try to understand the pathophysiology of it better, but even where we don't get it, at least we have robust empirical evidence that many therapies beat placebo, such that even if it's not actually a deficiency of serotonin, SSRIs still work modestly well in many if not most people. There are plenty of drugs with much more dramatic impact on psychiatric illnesses, I doubt any amount of psychological intervention would cure my ADHD while Ritalin does.
This "talking to the poor bastard" seems to me the point of the profession, or at least, to my mind, should be the pointy edge. The first step. The main thing.
I have precious little faith in psychologists, having known several in my life, but more in psychologists than therapists. Psychiatrists I would hold in highest regard; if there's a hierarchy in my mind they'd be up there at the top of the pyramid.
I suppose your speaking of cure here is relevant. There is this sense that we need cures and of course for many things cures are exactly what we need. I'm just as interested in causes and possible reversibility. Like when your liver is going, taking drugs to help the liver is less of a helpful strategy than quitting alcohol or whatever else you're doing to destroy your liver. That one is doing. Not you in particular.
I don't mean to come at you like this in any sort of aggressive way, I am just a skeptic of drugs in general, as I've said/written to you before.
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link
More options
Context Copy link